This invention relates to a device for use in laparoscopic or other minimally invasive surgery and more particularly to an improved access port for use in laparoscopic surgery.
In laparoscopic procedures, surgery is performed in the interior of the abdomen through a small incision. In endoscopic procedures, surgery is performed in any small area of the body through narrow or small diameter tubes inserted through a small entrance incision in the skin. Laparoscopic and endoscopic procedures generally require that any instrumentation that is inserted into the body be of minimal diameter and preferably be sealed with respect to the tissue of the patient to retain the gas that is added to insufflate the area of the surgery to create a working space for the surgeon. Moreover, laparoscopic and endoscopic procedures often require the surgeon to act on organs, tissues and vessels that are far removed from the incision, thereby requiring that any instruments used in such procedures be relatively long and of a small diameter. Additionally, because many of these procedures are performed on the abdomen or other areas that are visible to other people, there is a desire to use as few incisions as possible and to minimize the size and location of any resulting scars.
For such procedures, the introduction of a tube into the anatomical cavity, such as the abdomen, is usually accomplished through the use of a trocar assembly consisting of a port assembly and a trocar. The port assembly generally consists of a tubular port and a sealing member. Since the port assembly is in direct communication with the abdominal cavity of the patient, the sealing member must maintain a tight seal between the abdominal cavity and the atmosphere throughout the procedure, including as each instrument is inserted and manipulated therethrough. Surgical procedures in the abdominal cavity of the body, often require the use of insufflating gases to raise the cavity wall away from vital organs to form the working space. Therefore, a Veres needle is often used to initially pierce the abdominal wall and then introduce the gas into the abdominal cavity. Thereafter a pointed trocar is inserted into the port assembly and is used to pierce the abdominal wall. The gas raises the inner wall surface away from the vital organs thereby avoiding unnecessary and potentially dangerous contact with the organs as the instruments are inserted into the port assembly. Following removal of the trocar, laparoscopic or endoscopic instruments may then be inserted through the port assembly to perform surgery within the body cavity.
In view of the need to prevent leakage of the insufflation gas from the cavity, the port assembly is typically provided with a valve or seal assembly to permit introduction of the trocar and surgical instrument therethrough while minimizing communication between the abdominal cavity and the atmosphere. In this regard, there have been many attempts to provide a secure seal as part of the port assembly to allow for the secure insertion of a single instrument through the port. It frequently occurs during surgery that an additional instrument is temporarily required or desirable. Inserting this extra instrument typically involves creating an additional incision with a trocar. It is preferable that the number of incisions be minimized and that all of the required instruments remain in the cavity. Although larger port assemblies have been manufactured that may allow temporary access for multiple instruments through a single port, the seal may be lost and the insufflation gas will pass through leaks in the seal because the seals are designed for sealing around a single instrument. Additionally, as the second instrument is manipulated around the first instrument, the sealing member is unable to seal around the shaft of both instruments even if the surgeon is able to insert both instruments through the common port assembly. Therefore, the wall of the cavity will collapse and the likelihood of accidentally contacting tissue or organs with one or more of the instruments is increased.
At least one attempt has been made to allow the use of multiple instruments through a single port assembly. An example of this approach is disclosed in U.S. Pat. No. 5,395,367 granted to Wilk. In this disclosure, a device having multiple distal end effectors and multiple proximal actuators is disclosed. The device disclosed in the Wilk patent includes an elongate rigid sleeve having a pair of instruments movable therein. The rigid sleeve is inserted into a standard trocar sleeve or port assembly. The locking elements of this device are used to fix the position of the instruments relative to each other and limit the relative movement of the instruments through the rigid sleeve. Despite the availability of a plurality of end effectors through the common port assembly, this device still requires the use of a unique and relatively complicated instrument to perform multiple manipulations through the common port. Additionally, the instruments used with this device require that the end effectors be located adjacent to each other and cannot be oriented at different angles with respect to each other. Therefore, there is a need to provide a port assembly that allows the surgeon to use multiple instruments through a common incision. It is further desirable to allow the surgeon to use the instruments that they are familiar with and allow them to use a specialized port assembly that may be used with one instrument or a second instrument if desired without changing their technique.
An object of the present invention is to provide an improved port assembly and an associated method for facilitating laparoscopic or endoscopic surgery.
Another object of the present invention is to provide a port assembly that facilitates the utilization of an increased number of instruments without changing the technique of the surgeon or the number of incisions required to accomplish the desired procedure.
Yet another object of the present invention is to provide a port assembly that is sufficiently versatile to allow the surgeon to use the port assembly with either a single instrument or to add a second instrument through the same port.
Yet another object of the present invention is to provide a port assembly that is sufficiently versatile to allow independent movement and use of two instruments through the same port assembly.
Yet another object of the present invention is to provide a port assembly that includes floating valves to allow independent movement and use of two instruments through the same port assembly.
A preferred form of the present invention includes a port assembly that permits introduction of one or more elongate objects such as laparoscopic or endoscopic instruments therethrough. These instruments typically have a circular cross section and are inserted through the port assembly and into the body of the patient to perform the desired manipulation, cutting, suturing or removal desired by the surgeon. The port assembly of the present invention preferably includes a pair of floating valves or seals that allows independent dual access through the access opening of the port while maintaining a seal between the cavity and the atmosphere.
Additionally, one form of the present invention includes one or more valve bodies formed of a resilient material that will cause the flexible material surrounding the access opening to surround and resiliently engage the instrument or instruments in a substantially gas tight manner. The access opening may further include one or more slit valves or flexible flap members that are normally closed to further seal the port assembly. In a further embodiment, the access openings extend from the body of the port assembly such that individual sealing members may be used and opened by the individual instruments as the access is needed or desired. In this embodiment, the access openings open into a larger body area which is positioned in the tissue of the patient so that the separate manipulation of the instruments may be accomplished without affecting or compromising the substantially gas tight seal.
In yet another embodiment, the port assembly is preferably a rigid or semi-rigid member having a pair of sealing members therein. The sealing members may be individual slit or flap members such that the substantially fluid tight seal is formed around the individual instruments to allow individual manipulation of each instrument as desired.
The port assemblies of the present invention are preferably generally conically shaped and may be tapered from top to bottom to assist the surgeon with the insertion of the port assembly into the tissue of the patient. Alternately, the port assembly may be tapered inwardly towards the middle section with the distal and proximal sections being larger than the middle section to assist in retaining the tissue therebetween. In the first generally conical shape, the port assembly may also include an enlarged lip area to provide a stop surface for the port assembly such that the surgeon inserts the port assembly into the tissue of the patient up to the bottom surface of the lip member. Additionally, a smaller lip area may be located on the distal end portion to assist in retaining the port assembly in the tissue of the patient and contributing to the maintenance of the substantially gas tight seal.
An advantage of the present invention is that the port assembly allows the surgeon to use one or more instruments through the same incision while maintaining the substantially gas tight seal to maintain the insufflation of the desired cavity.
Another advantage of the present invention is that the surgeon may use straight and/or curved instruments with the present invention to obtain as much access as possible through a single incision while facilitating the performance of the surgical procedure by allowing the shaft of an additional instrument to be inserted adjacent to a first instrument on an as needed basis.
Yet another advantage of the present invention is that the port assembly provides the surgeon with the ability to separately manipulate the instruments through the separate access openings in the same port assembly to maximize the surgeon""s ability to manipulate and grasp the desired tissue.
A further advantage of the present invention is that the port assembly may be used in place of currently available port assemblies such that the port assembly of the present invention allows the surgeon to use their current techniques while allowing additional access in the event that an additional instrument is needed without requiring an additional incision or special instrumentation.